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Introduction

Concussion is a temporary loss of brain function due to a relatively mild injury to the brain. It is not necessarily associated with unconsciousness. Concussion is among the most commonly occurring forms of traumatic brain injury. It is sometimes referred to as mild traumatic brain injury. (“Mild” describes the severity of the initial physical injury, which is not life-threatening.) Recovery from a minor concussion is almost always complete.

Sometimes the term concussion is also used in reference to more severe brain injuries. These often involve a loss of consciousness. Some of the most common causes of concussion include motor-vehicle accidents, bicycle accidents, falls, and sports-related injuries. Sports- and recreation-related concussions are common in children. (See alsohuman disease.)

Causes

Concussion typically occurs following a hit to the head. However, an impact to another area of the body that also jars the head can result in a concussion. The resulting impairment to brain function generally is short-term. It usually resolves on its own within about 7–10 days.

Signs and Symptoms

Signs and symptoms of concussion vary. They may include physical symptoms, such as headache, vomiting, nausea, dizziness, sensitivity to light or sound, ringing in the ears, unsteady balance, slurred speech, blurry vision, and loss of consciousness. Cognitive problems include difficulty concentrating, feeling foggy or slow, and difficulty remembering what happened immediately before or after the injury. Emotional or mood changes include irritability, sadness, and nervousness. In addition, changing sleep patterns, such as sleeping more or less than usual, may occur.

Evaluation

Trained personnel should evaluate someone suspected of having a concussion. If the injured person is conscious, an evaluator should assess cognition. For example, the evaluator may ask the person to describe what happened. The evaluator should also check the person’s physical state. This task may include seeing if the person can balance correctly. The evaluator should also observe the individual for abnormal changes in personality or emotions. For instance, laughing following injury in an automobile accident would not be normal. Following on-site evaluation, an individual with a concussion typically sees a physician for further assessment.

Brain imaging techniques such as computed tomography (CT) scans and magnetic resonance imaging (MRI) are not able to detect the majority of concussions. However, doctors often use these methods to help rule out other problems that may exist after a hit to the head. These problems include bleeding or bruising in the brain.

Treatment

Individuals showing symptoms of a concussion require rest. This includes rest from both physical and cognitive activities. School-age children may require a reduced study load and an extended time for test taking. They may even benefit from a stay at home to allow for sufficient cognitive rest. Individuals must also refrain from activities that could result in a second impact to the head or body. These activities include playing sports, climbing on playgrounds, and riding bicycles. Athletes typically do not return to physical activity until their symptoms have gone away.

Postconcussive Syndrome

In some individuals, symptoms of a concussion last beyond three to four weeks. This results in a condition known as postconcussive syndrome. People with this syndrome may experience recurrent headaches, impaired memory, depression, ringing in the ears, anxiety, sensitivity to light, dizziness, and difficulty in concentrating and balancing. The development of postconcussive syndrome does not appear to be related to the severity of the concussion. People with postconcussive syndrome may need to take medication to control their symptoms.

Chronic Traumatic Encephalopathy

Jeff Siner—Charlotte Observer/MCT/Landov

Multiple concussions or a moderate or severe concussion can have long-lasting effects on the brain. Evidence indicates that severe concussion may eventually lead to mild cognitive impairment and chronic traumatic encephalopathy (CTE). Once associated with boxers, CTE is a degenerative brain disease. Symptoms include headache, depression, increased irritability, decreased ability to concentrate, loss of short-term memory, and suicidal behavior. The symptoms appear most commonly in midlife, often years after recovery from the initial head trauma.

Second-Impact Syndrome

Second-impact syndrome is a rare condition in which the brain swells. It may lead to death. The syndrome is thought to occur when an individual gets a second concussion when not fully recovered from the first one. However, scientists do not agree on whether the syndrome actually exists. Brain swelling can occur following any head injury. In most of the cases of second-impact syndrome, it is unclear whether the swelling was due to a solitary hit or to multiple hits to the head.

Prevention

Preventive measures can help reduce the likelihood of concussions. In sports, such measures include modifications to equipment, such as changing helmet designs. More effective rule enforcement or the development of new rules to limit hits to the head can also help prevent injuries. In addition, it is important to educate players, coaches, officials, and families about concussions. Wearing a seat belt when traveling by car can help prevent a head injury due to a crash.

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